Onco - Lung ppt

Question 1

true about lung cancer EXCEPT

a. lung cancer is most common cause of cancer death
b. lung cancer is common in young adults, above 20 years
c. the projected lifetime probability of developing lung cancer is 8% among males, and 6% among females
d. NOTA

Answer 1

B; uncommon below age 40, rates increase until age 80; rate tapers off

Question 2

Projected lifetime probability of developing lung cancer is estimated to be __ among males, and ___ among females

Answer 2

8% and 6% respectively

Question 3

cigarette smokes have increased risk of developing lung cancer compared to those who have never smoked by how much?

Answer 3

10-fold

Question 4

one genetic mutation is induced per this number of cigarettes smoked?

Answer 4

15

Question 5

Former smokers have an increased risk of developing lunch cancer compared to never smokers?

Answer 5

nine-fold

Question 6

the following statement/s are true

a. Smoking cessation does not reduce the risk of developing lung cancer compared to current smokers
b. Smoking cessation reduce the risk of cancer compared to those who don’t quit and the size of risk reduction is independent with the length of time the person has quit smoking
c. Environmental tobacco smoke and second hand smoking have the same risk of developing lung cancer as active smokers.
d. Exposure to asbestos, aresenic, bischloromethyl ether, hexavalent chromium, mustard gas, nickel and polycyclic aromatic carbons can cause lung cancer.

Answer 6

D
a and b. smoking cessation reduce the risk of developing lung CA and the longer a person has quit, the greater the risk reduction is.
c. Environmental tobacco smoke and second hand smoking has less risk for developing lung CA.

Question 7

Certain genetic polymorphisms of the ____ enzyme system, specifically ____ and chromosome fragility are associated with the development of lung cancer

Answer 7

P450

CYP1A1

Question 8

First degree relatives of lung cancer probands have a __ to ___ fold excess risk of lung cancer and other cancers, many of which are not smoking related

Answer 8

two to three

Question 9

inherited mutations in these genes may develop lung cancer

Answer 9

RB

p53

Question 10

Rare germline mutation involvng epidermal growth receptor linked to lung cancer susceptibility in never smokers

Answer 10

T790M

Question 11

A susceptibility locus on this chromosome greatly increases risk of lung cancer among light and never smokers

Answer 11

chromosome6q

Question 12

4 major cell types of lung cancers (WHO classification)

Answer 12

small cell lung cancer
adenocarcinoma
squamous cell carcinoma
large cell carcinoma

Question 13

cancer cell type related to heavy tobacco use

l

Answer 13

small cell lung CA

squamous cell carcinoma

Question 14

packyears to be considered light smoker

Answer 14

<10pack-year history

Question 15

most common cell type of lung cancer in <10packyear hx, women, <60y.o.

Answer 15

adenocarcinoma

Question 16

the following statements are true EXCEPT

a. the distinction between squamous and nonsquamous lung cancer is not critical to optimal therapeutic decision
b. daiagnosis of non-small cell carcinoma not otherwise sepcified is no longer considered acceptable
c. TTF-1 or Napsin A are adenocarcinoma immunohistochemistry marker
d. p40 or p63 are squamous markers

Answer 16

A

Question 17

Four categories for classifying predominant pattern of lung cancer

Answer 17

lepidic predominant
acinar and papillary
solid-predominant
micropapillary

Question 18

adenocarcinoma markers

a. p40
b. p53
c. p63
d. TTF-1

Answer 18

D

Question 19

adenocarcinoma markers

a. p40
b. p53
c. RB
d. napsin-A

Answer 19

D

Question 20

give 2 sqamous markers

Answer 20

p40 and p63

Question 21

favorable prognosis

a. lepidic
b. acinar
c. papillary
d. solid-predominant
e. micropapillary

(if answer is more than one, give both letters)

Answer 21

A

Question 22

poor prognosis

a. lepidic
b. acinar
c. papillary
d. solid-predominant
e. micropapillary

(if answer is more than one, give both letters)

Answer 22

D and E

Question 23

intermediate prognosis
favorable prognosis
a. lepidic
b. acinar
c. papillary
d. solid-predominant
e. micropapillary

(if answer is more than one, give both letters)

Answer 23

B and C

Question 24

types of squamous cell carcinoma (3)

Answer 24

keratinizing
nonkeratinizing
basaloid

Question 25

markers to verify neuroendocrine differentiation within a tumor (6)

Answer 25

``` neuron specific enolase (NSE) CD56 NCAM Synaptophysin chromogranin Leu7 ```

Question 26

________ is identified in tumors of thyroid and pulmonary origin, is positive in over 70% of pulmonary adenocarcinomas and is a reliable indicator of primary lung cancer, provided a thyroid primary has been excluded.

Answer 26

TTF-1

Question 27

______ is an aspartic protease that plays an important role in maturation of surfactant B7 and is expressed in cytoplam of type II pneumocytes

Answer 27

Napsin-A

Question 28

Nap A positive, TTF-1 positive a. primary lung adenocarcinoma b. primary lung squamous cell carcinoma c. primary SCLC

Answer 28

A

Question 29

Nap A negative TTF-1 positive a. primary lung adenocarcinoma b. primary lung squamous cell carcinoma c. primary SCLC

Answer 29

C

Question 30

Nap A negative TTF-1 negative a. primary lung adenocarcinoma b. primary lung squamous cell carcinoma c. primary SCLC

Answer 30

B

Question 31

CK7 negative CK20 negative a. nonsquamous NSCLC b. SCLC c. mesothelioma d. squamous cell ca

Answer 31

D; the others are CK7 positive, CK20 negative

Question 32

useful marker for detection of NSCLCs with sqamous differentiation when used in cytologic pulmonary samples a. p63 b. ROS1 c. KRAS d. ALK

Answer 32

A

Question 33

Several markers in the last few years have proven to be more helpful including ____, _____, _____, ` all of which show positivity in mesothelioma.

Answer 33

CK5/6 calretinin Wilms tumor gene-1

Question 34

True of MYC a. one of the earliest sets of oncogenes found to be aberrant b. most frequently activated via gene point mutation or transcriptional dysregulation in both SCLC and NSCLC c. Nearly 90% of SCLC harbor mutations in TP63 and RB1 d. AOTA

Answer 34

A | b. amplification instead of point mutation; TP53 instead of TP63

Question 35

Most common driver mutations in lung carcinoma

Answer 35

KRAS, but most cases are unkown

Question 36

True about early detection and screening EXCEPT a. in lung cancer, clinical outcome is related to the stage at diagnosis b. low dose non contrast, thin slice spiral chest CT has emerged as an effective tool to screen for lung cancer. c. a patient 45 year old, with history of 25 packyear history of cigarette smoking is a high risk patient d. former smokers must have quit within the previous 15 years

Answer 36

C; high risk individuals: between 55-74 years, >=30 packyear hx

Question 37

Describe the prototypical lung CA patient

Answer 37

current or former smoker, either sex, usually in the 7th decade of life

Question 38

Patient with chronic cough, without hemoptysis, 10 packyears, quit 15 years ago, 60 y.o. with COPD, the ff statements are true a. should prompt a thorough investigation for lung cancer b. if CXR is normal, no further tests needed c. both d. neither

Answer 38

A; hx of chronic cough with or without hemoptysis in a current or former smoker with COPD age 40 years or older should prompt a thorough investigation for lung cancer even in the face of a normal CXR

Question 39

A persistent pneumonia without constitutional symptoms merits a thorouguh investigation for underlying course if...

Answer 39

unresponsive to repeated courses of antibiotics

Question 40

lung cancer arising in a lifetime never smoker is more common in ____ and ____

Answer 40

women and East Asians, younger than their smoking counterparts

Question 41

_______ is required to confirm a diagnosis in all patients with suspected lung cancer

Answer 41

Tissue sampling

Question 42

Given greater emphasis placed on molecular testing for NSCLC patients, a ______ is preferred to ensure adequate tissue for analysis

Answer 42

core biopsy

Question 43

Tumor tissue maybe obtained via minimally invasive techniques such as (6)

Answer 43

``` bronchial biopsy transbronchial biopsy fiberoptic bronchoscopy FNA percutaneous biopsy EBUS guided biopsy ```

Question 44

biopsy is done in patients with

Answer 44

clinically palpable disease such as lymph node or skin metastasis

Question 45

Percutaneous biopsy is done in patients with suspected metastatic disease. Samples can be taken from

Answer 45

``` soft tissue mass lytic bone lesion bone marrow pleural lesion liver lesion adequate cell block obtained from a malignant pleural effusion ```

Question 46

True of lung cancer staging except a. lung cancer staging includes determination of location of tumor and metastatic sites and assessment of a patient's ability to withstand various antitumor treatments b. most significant dividing line is between those patients who are candidates for surgical resection and those who are inoperable but will benefit from chemotherapy, radiation therapy, or both. c. both d. neither

Answer 46

C

Question 47

give 4 contraindications ot potential curative resection in NSCLC

Answer 47

extrathoracic metastases superior vena cava syndrome vocal cord and, in most cases, phrenic nerve paralysis malignant pleural effusion cardiac tamponade tumor within 2 cm of the carina metastases to the contralateral lung metastases to supraclavicular lymph nodes contralateral mediastinal node metastases involvement of the main pulmonary artery

Question 48

1s FEV1 of greater than __ L or greater than ___% of predicted can tolerate a pneumonectomy

Answer 48

2L | 80%

Question 49

FEV1 greater than ___ L have adequate reserve for lobectomy

Answer 49

1.5L

Question 50

VO2 max of ___ mL/kg. min predicts for a higher risk of postoperative complications

Answer 50

<15

Question 51

in patients with myocardial infarction within the past 3 months is a contraindication to thoracic surgery. What percent of patients will die of reinfarction?

Answer 51

20%

Question 52

major contraindications for surgery include the ff EXCEPT a. uncontrolled arrhythmia b. FEV1 of less than 1L c. Co2 retention d. severe pulmonary hypertension e. resting PCO2 >35mmHg f. DLCO <40%

Answer 52

E; >45mmHg

Question 53

true for treatment of lung cancer metastatic disease a. platinum based chemotherapy for maintenance b. premetrexed for squamous c. gemcitabine for nonsquamous d. AOTA e. NOTA

Answer 53

A gemcitabine for squamous premetrexed for nonsquamous

Question 54

True of targeted therapy EXCEPT a. EGFR mutations have been detected in 10-20% of NOrth American patients diagnosed with NSCLC b. EGFR mutations are associated with younger age c. EGFR mutations associatied with <10 pack year and nonsmokers d. EGFR mutations associated with adenocarcinoma

Answer 54

A; 10-15%

Question 55

Exon deletions associated with EGFR

Answer 55

exon 21 exon 19 L8583

Question 56

FDA approved oral small molecule TKIs that inhibit EGFR

Answer 56

erlotinib gefitinib afatinib

Question 57

Disease progression occurs usually around how many months?

Answer 57

12months

Question 58

Approximately what percentage of patients harbor a second site mutation?

Answer 58

50%

Question 59

T790M mutation occur within exon ___

Answer 59

exon 20

Question 60

Third gen mutant selective EGFR TKI specific for T790M

Answer 60

Osimertinib

Question 61

Similar to EGFR, ___ rearrangements are typically but not exclusively associated with younger age, light <10packyear and nonsmokers, and adenocarcinoma histology

Answer 61

ALK